The recommendations of the eGFR working group are a first step towards equity

October 18, 2021

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The healthcare community has struggled with ways to improve equity in patient care, and the dialysis and kidney transplant profession has been part of the effort.

Last month, a joint National Kidney Foundation and American Society of Nephrology working group – formed over a year ago – released their final report1 on Considering Race in Diagnosing kidney disease and described an approach that recommends adopting a new equation that estimates kidney function without a racial variable.

Mark E. Neumann

The report, published online in the American Journal of Kidney Diseases and Journal of the American Society of Nephrology, was written with “input from the medical community and patients to identify an approach that balances social justice with scientific rigor”, Cynthia Delgado MD, FASN, associate professor of medicine, San Francisco Veterans Affairs Healthcare System and University of California, San Francisco, and co-chair of the joint NKF-ASN working group, said in a press release.

Recommendations

In the article, of which she was the lead author, Delgado and her colleagues made the following recommendations:

  • for adults in the United States, 85% of whom have normal renal function, clinicians should “implement the use of [Chronic Kidney Disease Epidemiology Collaboration] CKD-EPI creatinine equation redone without race variable in all labs in the US because it does not include race in calculating and reporting, includes diversity in its development, is immediately available to everyone laboratories in the United States and exhibits acceptable performance characteristics and potential consequences that do not disproportionately affect a group of individuals, ”the authors wrote;
  • national efforts should be made to “facilitate the increased, systematic and timely use of cystatin C, in particular to confirm eGFR in adults at risk for or with chronic kidney disease, because the combination of filtration markers (creatinine and cystatin C) is more precise and supports better clinical decisions than either of the markers alone; ” and
  • that “research on estimation of GFR with new endogenous filtration markers and on interventions aimed at eliminating racial and ethnic disparities should be encouraged and funded,” wrote Delgado and colleagues.

Equity in care

The working group’s recommendation “is an important step forward to ensure health and equity of care … The NKF and ASN urge all laboratories and health systems in the country to adopt this new approach as quickly as possible. possible so that we can move towards a consistent, breed-independent method of diagnosing kidney disease ”, Paul M. Palevsky, MD, FASN, FNKF, NKF president said in the statement.

The task force’s accomplishments are a good start towards the goal of ensuring that everyone with kidney disease is treated fairly. As part of this effort, CMS has proposed a set of modifications to the ESRD Treatment Choices (ETC) model for 2022 that offers dialysis clinics additional financial rewards if clinics show a provision of equity in dialysis care and home transplantation.

In the proposal, a “health equity incentive” for the improvement scoring methodology for home dialysis rate and transplant rate would be offered to dialysis clinics that demonstrate significant improvement in rates. home dialysis or transplant recipients who are doubly eligible for Medicare and Medicaid or Low Income Grants (LIS) recipients. In addition, further stratifying the success criteria by the proportion of beneficiaries who are doubly eligible for Medicare and Medicaid or who are LIS beneficiaries for ETC clinics that see a high volume of these patients would not experience negative financial consequences by result.

Palevsky agreed that there was still work to be done. “While the task force’s work is an important initial path, our two organizations are committed to continuing to work to eliminate disparities in the diagnosis and treatment of kidney disease,” he said.

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